Clinical effect of cardiopulmonary resuscitation with active abdominal compression-decompression

Abstract

To explore the resuscitation effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) on patients with cardiac arrest. The patients with cardiac arrest admitted to emergency medical center of Hainan General Hospital from June 2014 to January 2016 were enrolled, who were satisfied with the indication of AACD-CPR and had no contraindication for AACD-CPR, and with 40-150 kg weight and over 16 years old. All of enrolled patients were given mechanical ventilation and conventional drug rescue. At the same time, AACD-CPR was performed with the active abdominal compression-decompression device, the rhythm of abdominal compression-decompression was 100 bmp and the ratio of compression time to lift time was 1:1, the pressure intensity was approximately 50 kg and the lifting intensity was approximately 30 kg. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2) and blood lactic acid (Lac) were recorded before and after CPR, and restoration of spontaneous circulation (ROSC) were calculated. Forty-one patients with cardiac arrest were enrolled, with 22 males and 19 females, and the age between 15 years old and 89 years old, with an average (66.5±18.8) years old. The etiologies of cardiac arrest were followed: cardiogenic for 10 cases, non-cardiogenic for 18 cases, and unknown causes for 13 cases. The rate of ROSC in patients with AACD-CPR was 19.5% (8/41). During the resuscitation, the HR, MAP and SpO2 of those patients were significantly improved compared with those index suffering the cardiac arrest [HR (bmp): 67.0 (48.0, 105.0) vs. 0.0 (0.0, 11.5), MAP (mmHg, 1 mmHg = 0.133 kPa): 23.0 (16.0, 37.0) vs. 0.0 (0.0, 0.0), SpO2: 0.79 (0.45, 0.90) vs. 0.00 (0.00, 0.32), all P < 0.01]. During the resuscitation and 0.5 hours after ROSC, the indexes of the ROSC patients were significantly improved compared with those suffering cardiac arrest [HR (bmp): 88.5 (53.8, 105.0), 94.5 (72.5, 129.3) vs. 0.0 (0.0, 17.3); MAP (mmHg): 48.0 (41.3, 66.0), 54.0 (42.0, 72.5) vs. 0.0 (0.0, 0.0); SpO2: 0.74 (0.64, 0.80), 0.89 (0.81, 0.93) vs. 0.00 (0.00, 0.42); all P < 0.05]; in addition, the Lac of patients was not increased in the resuscitation and 0.5 hours after ROSC compared with the status before cardiopulmonary resuscitation (mmol/L: 4.44±1.66, 3.71±1.33 vs. 3.95±1.71, both P > 0.05). Besides, the ROSC rate of patients who suffered cardiac arrest before pre-hospital care or in emergency ward [11.1% (2/18)] were lower than those the patients who suffered cardiac arrest in emergency intensive care unit [EICU, 26.1% (6/23)]; while the cardiac arrest patients who didn't experienced AACD-CPR until they got complications such as thoracic rib fracture after standard cardiopulmonary resuscitation (STD-CPR), the ROSC rate of those patients in pre-hospital care or in emergency ward [10.0% (1/10)] were lower than the ROSC rate of the patients who suffered cardiac arrest in EICU [20.0% (4/20)], but there was no significant difference between the two groups (both P > 0.05). AACD-CPR is effective in the treatment of sudden cardiac arrest patients with contraindication of chest compression, and makes up for the deficiency of STD-CPR.